MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

On this blog we have seen just about every variation of misdemeanors by practitioners of so-called alternative medicine (SCAM). Today, I will propose a scale and rank order of these lamentable behaviours. As we regularly discuss chiropractic and homeopathy here, I decided to use these two professions as examples (but I could, of course, have chosen almost any other SCAM).

  1. Treating conditions which are not indicated: SCAM practitioners of all types are often asked by their patients to treat conditions which their particular SCAM cannot not affect. Instead of honestly saying so, they frequently apply their SCAM, wait for the natural history of the condition to do its bit, and subsequently claim that their SCAM was effective.
  2. Over-charging: asking too much money for services or goods is common (not just) in SCAM. It raises the question, what is the right price? There is, of course, no easy answer to it. Over-charging is therefore mostly a judgement call and not something absolute.
  3. Misleading a patient: there are numerous ways in which patients can be misled by their SCAM practitioners. A chiropractor who uses the Dr title, without explaining that it is not a medical title, is misleading his/her patients. A homeopath who implies that the remedy he/she is selling is a proven treatment is also misleading his/her patients.
  4. Being economical with the truth: the line between lying (see below) and being economical with the truth is often blurred. In my view, a chiropractor who does not volunteer the information that acute back pain, in most cases, resolves within a few days regardless of whether he/she mapipulates the patient’s spine or not, is economical with the truth. Similarly, a homeopath who does not explain up front that the remedy he/she prescribes does not contain a single active molecule is economical with the truth.
  5. Employing unreasonably long series of therapy: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition, should suggest to call it a day. Patients should be given a treatment plan at the first consultation which includes the information when it would be reasonable to stop the SCAM.
  6. Failing to refer: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition should refer the patient to another, better suited healthcare provider. Failing to do so is a serious disservice to the patient.
  7. Unethical behaviour: there are numerous ways SCAM practitioners regularly violate healthcare ethics. The most obvious one, as discussed often before on this blog, is to cut corners around informed consent. A chiropractor might, for instance, not tell his/her patient before sarting the treatment that spinal manipulation is not supported by sound evidence for efficacy or safety. A homeopathy might not explain that homeopathy is generally considered to be implausible and not evidence-based.
  8. Neglect: medical neglect occurs when patients are harmed or placed at significant risk of harm by gaps in their medical care. If a chiropractor or a homeopath, for instance, claim to be able to effectively treat asthma and fail to insist that all prescribed asthma medications must nevertheless be continued – as both often do – they are guilty of neglect, in my view. Medical neglect can be a reason for starting legal proceedings.
  9. Lying: knowingly not telling the truth can also be a serious legal issue. An example would be a chiropractor who, after beeing asked by a patient whether neck manipulation can cause harm, answers that it is an entirely safe procedure which has never injured anyone. Similarly, if a homeopaths informs his/her patient that the remedy he/she is prescribing has been extensively tested and found to be effective for the patient’s condition, he must be lying. If these practitioners believe what they tell the patient to be true, they might not technically be lying, but they would be neglecting their ethical duty to be adequately informed and they would therefore present an even greater danger to thier patients.
  10. Abuse: means to use something for the wrong purpose in a way that is harmful or morally wrong. A chiropractor who tells the mother of a healty child that they need maintenance care in order to prevent them falling ill in the future is abusing her and the child, in my view. Equally, I think that a homeopath, who homeopathically treats a disease that would otherwise be curable with conventional treatments, abuses his patient.
  11. Fraud: fraud is a legal term referring to dishonest acts that intentionally use deception to illegally deprive another person or entity of money, property, or legal rights. It relies on the use of intentional misrepresentation of fact to accomplish the taking. Arguably, most of the examples listed above are fraud by this definition.
  12. Sexual misconduct: the term refers to any behaviour which is sexual in nature and which is unwelcome and engaged in without consent. It ranges from unwanted groping to rape. There is, for instance, evidence that sexual misconduct is not a rarety in the realm of chiropractic. I have personally served once as an expert witness against a SCAM practitioner is a court case at the Exeter Crown Court.

The 12 categories listed above are not nearly as clearly defined as one would wish, and there is plenty of overlap. I am not claiming that my suggested ‘scale of misdemeanors by SCAM practitioners‘ or the proposed rank order are as yet optimal or even adequate. I am, however, hoping that readers will help me with their suggestions to improve them. Perhaps your input might then generate a scale of practical use for the future.

12 Responses to A scale of misdemeanors by SCAM practitioners towards patients and the public

  • This seems like an extremely valuable list.

    Perhaps ‘being economical with the truth’ could be tightened up to refer to overestimating the accuracy of diagnostic skills and methods?

    Maybe also the general failure/refusal to keep proper systematic records of diagnosis, treatments and progression of the illness (or whatever the medical term is).

  • 4. “Similarly, a homeopath who does not explain up front that the remedy he/she prescribes does not contain a single active molecule is economical with the truth.”
    You are right!

    But I didn´t know , that you are still living in medieval theories of matter and effects!

    5. ” A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition, should suggest to call it a day.”
    You are right!
    So:
    “IMMEDIATE Remission of an Inguinal Lymph Node Afflicted with Large-Cell B-Non-Hodgkin’s Lymphoma Under Sole Homeopathic Treatment with Conium: When Is a Sole Adjuvant-Homeopathic Tumor Therapy Permissible and Useful?
    https://www.karger.com/Article/FullText/500122

    6.”Failing to refer: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition should refer the patient to another, better suited healthcare provider. Failing to do so is a serious disservice to the patient.”
    You are right!
    “A control computed tomography on the oncological side, which was carried out on November 20, 2018, did not reveal any evidence of a recurrence of B non-Hodgkin lymphoma; Laboratory controls on November 5, 2018 and February 12, 2019 with special observation of LDH remain normal.
    To date (March 1st, 2019) the patient has not shown any subjective or clinical signs of relapse. Further regular and close-knit check-ups by the oncologist have been agreed.” (link see above) [to date 23.12.20 same!]
    […]

    9.”Fraud: fraud is a legal term referring to dishonest acts that intentionally use deception to illegally deprive another person or entity of money, property, or legal rights. It relies on the use of intentional misrepresentation of fact to accomplish the taking. Arguably, most of the examples listed above are fraud by this definition.”
    You are right!
    But:
    EDZARD ERNST:
    “A new study of homeopathy suggests that highly diluted remedies are better than placebos (and I cannot fault it)
    […]
    As far as I can see, there are the following possibilities:

    fraud,
    coincidence,
    some undetected/undisclosed bias,
    HOMEOPATHY WORKS AFTER ALL”
    https://edzardernst.com/2019/02/a-new-study-of-homeopathy-suggests-that-highly-diluted-remedies-are-better-than-placebos-and-i-cannot-fault-it/

    !!!… and do not come to me now with the argument of the counter arguments in the blog discussion:
    Why were these not officially asserted in a letter to the editor? Maybe they weren’t that impressive after all?

    • 1) ” medieval theories of matter and effects!”
      I was not aware that it ever existed; did they not even in the middle ages that heat, cold, etc. have effects?
      2) your infamous case report!
      did we not discuss it ad nauseam before?
      3) ““A new study of homeopathy suggests that highly diluted remedies are better than placebos (and I cannot fault it)”
      as you know, others did fault it; but even if it had been faultless – did you not know that, amongst 100 trials, 5 will yield a significant result on the conventional level of statistical significance?
      4) “and do not come to me now with the argument of the counter arguments in the blog discussion:
      Why were these not officially asserted in a letter to the editor? Maybe they weren’t that impressive after all?”
      oh dear! firstly, I never come to you. secondly, perhaps people think it’s too trivial to point out that homeopathics are placebo?

  • I guess Misdemeanors are better than the Felonies committed by the CON-Med practitioners: murder, fraud, theft, etc.

  • “A chiropractor who uses the Dr title, without explaining that it is not a medical title, is misleading his/her patients.”

    I suppose that would also hold true for dentists, physical therapists and optometrists.

    Of course the title doctor was originally given to a small group of theologians.

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